Provider Demographics
NPI:1831727742
Name:GOMEZ-MEDINA, KAREN (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GOMEZ-MEDINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-0558
Mailing Address - Country:US
Mailing Address - Phone:956-961-8555
Mailing Address - Fax:
Practice Address - Street 1:1605 E INTERSTATE HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6616
Practice Address - Country:US
Practice Address - Phone:956-585-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant